Wounds. wound process. Their classification, treatment, drugs.

Wounds. wound process. Their classification, treatment, drugs.

1. Wounds. wound process.
The presentation used its own materials and materials from
open sources (Internet).
Department of General Surgery with
courses transplantology and radiology,
IAPE,
Garaev Marat Railevich, Ufa, 2023

2. Wound - tissue damage, characterized by a violation of the
integrity of the skin or mucous membrane caused by mechanical
action.

The main clinical signs of wounds are:
- pain,
- bleeding
- gaping.

In each case, their expression
depends on the location of the wound
damage mechanism, volume
and depth of injury, as well as
general condition of the patient.


A wound is also called an open injury, since the main criterion for a
wound is a violation of the integrity of the integument of the body.
Definition

3. 1. Due to the occurrence:

Mechanical (traumatic) wounds - arise as a result of a variety of
physical influences (surgical wounds, wartime wounds, etc.). The
type of traumatic effect and the extent of damage determine further
classification in terms of prognosis and treatment.

Thermal and chemical wounds result from exposure to heat
(burns) and cold (frostbite), tissue-damaging radiation, acids or
alkalis (chemical burns). (Discussed in the previous lecture).
Wound classifications

4. 2. According to the mechanism (nature) of tissue damage:


-gunshot
-stab
-cut
-сhopped
-bruised
-crushed
-ragged
-bitten…

Wound classifications

5. Wound classifications
2.1 Gunshot wound

6. Wound classifications
2.2 Stab wound

7. Wound classifications
2.3 Cut wound

8. Wound classifications
2.4 Bruised wound

9. Wound classifications
2.5 Crushed wound

10. Wound classifications
2.6 Bitten wound

11. Wound classifications
2.7 Ragged wound

12. Wound classifications
2.8 Chopped wound

13. 3. By depth:

Superficial (within the skin, subcutaneous tissue);







Deep: - non-penetrating
- penetrating (- if they
penetrate into the underlying cavity:
no damage or
with damage to internal
organs).

Wound classifications

14. 4. By the nature of the wound channel:
Through wounds :









Blind:







Wound classifications

15. 4. By the nature of the wound channel (continued):

Tangents:







Scalped:



Wound classifications

16. 5. According to the degree of contamination and the presence
of infection in the wound:

Operating rooms (sterile):



Random (always
considered infected):



Wound classifications

17. Any accidental wound is bacterially contaminated
(infected).

However, the presence of infection in the wound does not
always lead to the development of a purulent process.

For the development of a purulent process, 3 factors are
important:
1. The nature and degree of tissue damage;
2. The presence of blood in the wound, foreign bodies, non-
viable tissues;
3. The presence of pathogenic pathogens in sufficient
concentration.

18. For the development of infection in the wound, the concentration of
microorganisms is 100000 microbial bodies per 1 gram of tissue.
This is the so-called "critical" level of bacterial contamination.
It is believed that only when this concentration of microbes is
exceeded, the development of infection in intact normal tissues is
possible. But the "critical" level can go down. For example, in the
presence of blood, foreign bodies, suture material in the wound,
10000 microbial bodies are sufficient for the development of
infection. And with tight tightening of ligatures and the resulting
malnutrition of tissues (ligature ischemia), 1000 microbial bodies
per 1 gram of tissue are sufficient.

19. When applying any wound (operational, accidental), a wound process
develops.

Wound process - it is a complex set of local and general body reactions that
develop in response to tissue damage and infection.

The course of the wound process is conditionally divided into 3 main phases:
1. Inflammation phase:
a) the period of vascular changes, b) the period of wound cleansing;
2. Regeneration phase;
3. Phase of scar organization and epithelialization.

Wound process

20. Wound process

21. Wound process

22. Wound process

23. Wound process

24. Wound process

25. In the first phase of the wound process, the following are
observed:
1.Change in vascular permeability with increasing exudation;
2.Migration of leukocytes and other cellular elements from the
bloodstream to the area of ​​injury;
3. Swelling of collagen and synthesis of the main substance;
4. Acidosis due to oxygen starvation.

In phase I, along with exudation, there is also absorption (resorption)
of toxins, bacteria, and tissue decay products. The process of
resorption from the wound continues until it is closed by granulations.
With extensive purulent wounds, resorption of toxins leads to
intoxication of the body, resorptive fever occurs.

26. II phase (regeneration phase) - granulation formation, i.e. tender
connective tissue with newly formed capillaries.








III phase (phase of scar organization and epithelialization)- in
which the delicate connective tissue is transformed into a dense scar,
and epithelialization begins from the edges of the wound.

27. Primary wound healing (primary intention) - when the edges of the
wound come into contact and there is no infection, for 6-8 days. Surgical
wounds generally heal by primary intention.
Types of wound healing

28.  Secondary healing (secondary intention) - with suppuration of
wounds or large diastasis of the edges of the wound. In this case, the
wound is filled with granulations, the process is long, for several weeks.
Types of wound healing (continuation)

29.  Wound healing under a scab. This is how superficial wounds usually
heal, when they are covered with blood, cellular elements, a crust forms.
Epithelization goes under this crust.
Types of wound healing (continuation)

30. Wound treatment
Allocate surgical treatment of wounds and medical treatment of wounds.
There are several types of surgical treatment of wounds:

Primary surgical treatment or debridement (PST or PSD) is
performed for any accidental wound in order to prevent the development
of infection.

Secondary surgical treatment of the wound - is performed according
to secondary indications, in the process of treatment, already against the
background of an infection that has developed.
Depending on the timing of the surgical treatment of wounds (STW),
there are:

Early STW- performed within the first 24 hours to prevent infection;
Delayed STW- performed within 48 hours, subject to prior use of
antibiotics;
Late STW- is made after 24 hours, and with the preliminary use of
antibiotics - after 48 hours, and is already aimed at treating an
infection that has developed.

31. Wound treatment
Surgical treatment of a stab wound consists of 3 stages:

1. Dissection of tissues: a stab wound must be transferred to a cut
wound;
2. Excision of the edges and bottom of the wound, removal of foreign
bodies;
3. Revision of the wound channel in order to exclude a penetrating wound
in the cavity (pleural, abdominal, joint, skull, etc.)

32. Wound treatment
Surgical treatment of wounds (STW) is completed by suturing.

Distinguish: 1. Primary seam - immediately after PST;

2. Delayed suture - after PST, sutures are applied, but not tied, and only
after 24-48 hours the sutures are tied if the wound has not developed an
infection.

3. Secondary suture - after cleansing the granulating wound (after 10-12
days).

33. Treatment of purulent wounds
Treatment of purulent wounds must correspond to the phases of the
course of the wound process!

In the first phase - inflammation - the wound is characterized by
severe exudation (cloudy exudate in the wound), tissue necrosis, the
development of inflammation symptoms (edema, hyperemia,
hyperthermia, soreness), absorption of toxins.

Treatment objectives:
1.Removal of pus and necrotic tissues;
2.Reduction of edema and exudation;
3.Fight against microorganisms.

34. Treatment of purulent wounds
Local treatment of purulent wounds in the 1st phase of the wound
process includes methods such as:
1. Excision of necrosis (necrectomy);
2. Wound drainage: passive, active;
3. Application of hypertonic solutions;
4. Ointments with antibiotics;
5. Enzyme therapy (use of proteological enzymes);
6. Use of antiseptic solutions;
7. Physical methods of antiseptics (quartzization of wounds, ultrasonic
cavitation of purulent cavities, hyperbaric oxygenation);
8. Application of the laser.

35. Treatment of purulent wounds
Local treatment of purulent wounds in the 2st phase of the wound
process. Treatment objectives:
1.Further antimicrobial and anti-inflammatory treatment;
2.Stimulation of regeneration (formation of new tissue);
3.Protection of the emerging granulation tissue from damage.
These tasks are met by the use of such methods as:
a) Application for dressing ointments: Levosin, Levomekol - to fight infection and
stimulate regeneration;
b) The use of modern dressings that do not stick to the wound surface and are
easily removed during dressing (mesh dressings with ointments, alginate dressings,
hydroactive dressings, etc.)
c) the use of a laser - in this phase of the wound process, low-energy (therapeutic)
lasers are used, which have a stimulating effect on the growth of granulations;
d) the use of vacuum therapy.
e) the use of drugs with the inclusion of ingredients of natural origin - aloe juice,
sea buckthorn and rosehip oil, kolanchoe, beeswax, etc.

36. Ultrasonic treatment of wounds
Application:
The solution enters the device through a system of tubes (a system for
intravenous infusions is used) and is fed to the wound through the
sonotrode irrigation channel. The solution is supplied from the container
under the influence of gravity.
As a working solution (acoustic medium) are usedvarious sterile
solutions. Depending on the clinical situation, it is possible to use
solutions of any antiseptics, multicomponent salt solutions (more
commonly used: 0.02% lavasept solution, 0.9% NaCl solution, 0.02%
chlorhexidine solution).

37. Laser treatment of wounds
Example of the result of the application of the laser processing
method

A patient with diabetic foot syndrome (during and after CO2 laser treatment).

The method allows bloodlessly and quickly evaporates damaged tissues, destroys
microorganisms.

Anesthesia is regional (spinal).

38. Treatment of purulent wounds
Local treatment of purulent wounds in the 3st phase of the wound
process. Treatment objectives:
1.Continue to protect the emerging granulation tissue from damage;
2.Accelerate the process of epithelialization and scarring of wounds.

Treatment includes:
The use of protective bandages.
With extensive skin defects, long-term non-healing wounds and ulcers in
the 2nd and 3rd phases of the wound process, that is, after cleansing the
wounds from pus and the appearance of granulations, dermatome (skin)
plasty or combined wound plasty can be performed (partially closed by
applying secondary sutures, partially - by skin grafting.).

39. An example of the treatment of a purulent -necrotic wound at
different stages

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